CHIKUNGUNIYA -PATHO PHYSIOLOGY MANAGEMENT
Chikungunya is a mosquito-borne viral disease first described during an outbreak in southern Tanzania in 1952. It is an RNA virus that belongs to the alphavirus genus of the family Togaviridae. In 2006, total 13,90,322 clinically suspected cases of Chikungunya were reported from 16 States/UTs in India.This Chikungunya fever guideline is published by the Directorate of National Vector Borne Disease Control, Govt of India in the year 2016. This guideline synopsis is dedicated to the Clinical management of Chikungunya. The information also covers the origin of the disorder, its epidemiology, diagnostic evaluations of the tests and management of the disease. Clinical Management of Chikungunya guidelines are summarized as follows: Since 1960, the outbreaks of the Chikungunya disease in South Eastern Asia were reported from India, Sri Lanka, Myanmar, Thailand, Indonesia, Philippines and Malaysia. Chikungunya outbreaks typically result in large number of cases but deaths are rarely encountered. Transmission and Trends: Chikungunya fever epidemics display cyclical and seasonal trends. There is an inter-epidemic period of 4-8 years (sometimes as long as 20 years). Outbreaks are most likely to occur in post-monsoon period when the vector density is very high and accentuates the transmission. Human beings serve as the Chikungunya virus reservoir during epidemic period. Types of Laboratory Tests available For Detection of Chikungunya Virus: Virus Isolation (Exposing cell lines samples from blood). Serological Diagnosis (ELISA IgM Specific). RT-PCR. Differential Diagnosis: Dengue Fever Malaria Leptospirosis Enteric Fever Rheumatic Fever Reactive arthritis Serum sickness illness Rickettsial disease Clinical Features: Acute phase: Less than 3 weeks Sub-acute phase: > 3 weeks to 3 months Chronic phase: > 3 months Symptoms: Fever Arthralgia/Arthritis Backache Headache Skin rash/Itching Symptoms which are seen in Children (Rarely in Adults) Photophobia Retro-orbital pain Vomiting Diarrhea Meningeal syndrome Acute encephalopathy Long course symptoms: Arthralgia Myalgia Arthritis Persistent Joint stiffness Restricted joint movement Painful joint movement Enthesopathy Tendinnitis Skin pigmentation Skin rash Impact of chikungunya on Pregnancy: A pregnant woman can get affected with the chikungunya virus at any stage of pregnancy. The time of huge risk of Chikungunya virus transmission from a mother to a fetus appears to be during birth. Chikungunya is more deadly in children as compared to adults because children cannot express exact symptoms and it may take time to diagnose the disease. Chikungunya in Elderly: The elderly are affected in more serious manner than the younger population. The body resistance is low in case of elderly and this causes the debilitating effects on their bodies. Chikungunya in elderly people could cause cerebral problems like dementia and paralysis and kidney disorders. Chikungunya Co-infection with Dengue: This is not very unusual as both Dengue and Chikungunya are arboviral diseases, transmitted by the same Aedes mosquitoes. The other observed symptoms in the patients who are suffering from infections of chikungunya and dengue are other non-specific constitutional symptoms such as anorexia, vomiting, headache, and muscle or joint pains and subjected the samples to Chikungunya serology as well. Guidelines for Management of the Chikungunya Disease: Management during Acute and sub-acute phase of the illness Management during Chronic phase or Sequelae. There is no antiviral drugs against Chikungunya Most of the signs and symptoms are self-limiting. Treatment for Chikungunya is purely symptomatic-supportive care and rest and nutrition Analgesics, antipyretics and fluid supplementation are important aspects in managing this infection. Supportive or Palliative Medical Care With Anti-inflammatories Supportive care with rest is indicated during the acute joint symptoms. Movement and mild exercise tend to improve stiffness and morning arthralgia, but heavy exercise may exacerbate rheumatic symptoms. There Is No Vaccine Currently Available. Disabling peripheral Arthritis/ Artropathy refractory to NSAID: Short term corticosteroid may be used. Long term anti-inflammatory therapy Physiotherapy Chloroquine phosphate Management of Chikungunya with High risk group: Proper management of Co-morbid condition and co-infection. Through the recent epidemics, Chikungunya has demonstrated its ability to spread and infect large proportions of the population. There is a very good chance that Chikungunya will continue to spread unless measures are taken to improve the recognition of the disease, to control the vectors responsible for the transmission Show Less